| National Provider Identifier [NPI]: | 1043270812 |
| Last Name Of The Provider | TAYLOR |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | O. D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 431 W COLISEUM BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468051010 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 914 |
| Number Of Medicare Beneficiaries | 300 |
| Total Submitted Charge Amount | 90095 |
| Total Medicare Allowed Amount | 73988.47 |
| Total Medicare Payment Amount | 50372.08 |
| Total Medicare Standardized Payment Amount | 54747.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 914 |
| Number Of Medicare Beneficiaries With Medical Services | 300 |
| Total Medical Submitted Charge Amount | 90095 |
| Total Medical Medicare Allowed Amount | 73988.47 |
| Total Medical Medicare Payment Amount | 50372.08 |
| Total Medical Medicare Standardized Payment Amount | 54747.17 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 108 |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 59 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 194 |
| Number Of Male Beneficiaries | 106 |
| Number Of Non Hispanic White Beneficiaries | 222 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 150 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 150 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3514 |